From SF’s front lines — social worker who deals with...

1of4Rachel Rodriguez works with Lawrence Rosenberg to get a check at a Community Payee Partnership office.Photo: Photos by Lea Suzuki / The Chronicle

2of4Above: Rachel Rodriguez (l to r), director and co-founder Community Payee Partnership, and client Thomas Soto talk with Moe Najjar, Ser-Well Market Liquors staff, as they check in regarding Soto's store account on Thursday, March 7, 2019 in San Francisco, Calif. Left: Rachel Rodriguez (l to r), director and co-founder Community Payee Partnership, walks with client Thomas Soto as they check in at a store that helps maintain an account for him on Thursday, March 7, 2019 in San Francisco, Calif.Photo: Lea Suzuki / The Chronicle

3of4Rachel Rodriguez (l to r), director and co-founder Community Payee Partnership, talks with client Louie Yip as he picks up a check at a Community Payee Partnership office on Thursday, March 7, 2019 in San Francisco, Calif.Photo: Lea Suzuki / The Chronicle

4of4Rachel Rodriguez (lto r), director and co-founder Community Payee Partnership, and client Lawrence Rosenberg sign paperwork as Rosenberg picks up a check at a Community Payee Partnership office on Thursday, March 7, 2019 in San Francisco, Calif.Photo: Lea Suzuki / The Chronicle

Six months ago, then-Gov. Jerry Brown signed state Sen. Scott Wiener’s legislation allowing San Francisco, San Diego and Los Angeles to start a five-year pilot program expanding the state’s conservatorship law to apply to those who have a severe drug addiction.

Currently, counties can compel some people into treatment if they’re severely mentally ill or addicted to alcohol, but not if they’re hooked on drugs. Any walk around the Tenderloin, Mid-Market and South of Market shows there are plenty of candidates in that third category.

Each county can decide for itself whether to participate. Mayor London Breed and Supervisor Rafael Mandelman have teamed up on local legislation that would direct San Francisco to test the program.

So it’s all settled, right? Six months is plenty of time to decide to participate.

Supervisor Hillary Ronen is the chair of the supervisors’ Rules Committee, the group that will eventually take up the matter. She said nobody’s asked her to schedule the hearing, and she’s leaning toward voting no on the pilot program because it’s been determined that it will help only a handful of people.

Also, she’s concerned there is no long-term plan for those who participate. Ronen is certainly correct when she says there are far too few drug treatment slots available and far too few mental health beds. It’s something everybody at City Hall seems to acknowledge but not do much to solve.

Wiener is pushing a “clean-up bill” so the legislation could expand to include the 50 to 100 severely drug-addicted people who backers say should be compelled into treatment. He wants the supervisors to approve the pilot so they’re ready to go if Gov. Gavin Newsom signs the new legislation in September.

The program wouldn’t round up any drug user in San Francisco — far from it. The legislation would apply only to those who’ve been 5150’ed eight times — eight times! — in one year, meaning they’ve been taken to a psychiatric unit for up to three days because they’re so high, they’re a danger to themselves or others.

“Tragically, that covers far more people than anyone would ever think,” Wiener said. “It’s about helping people who are in crisis and are dying on our streets.”

Rachel Rodriguez (l to r), director and co-founder Community Payee Partnership, walks with client Thomas Soto as they check in at a store that helps maintain an account for him on Thursday, March 7, 2019 in San Francisco, Calif.

Photo: Lea Suzuki / The Chronicle

It’s time to opt in to any program that would help these people rather than taking the so-called “compassionate” route and waiting for them to decide they want help as they waste away in front of us. I was even more convinced of this after an interview with Rachel Rodriguez, a social worker in the psych unit at St. Francis Memorial Hospital at Hyde and Bush streets.

The 40-year-old Manhattan native knew she wanted to work in the mental health field after being raised above her family’s Irish pub. Her mom was “a caretaker and social justice warrior” for area homeless people, she said, bringing them food on metal carts and taking them to the hospital when they were sick.

Rodriguez moved to San Francisco at age 18 to attend the University of San Francisco, thinking she would become a psychiatrist. But when she got pregnant her junior year, she knew she needed to get a degree more quickly and start working, and she landed in social work. She received her master’s of social work degree from UC Berkeley in 2003.

In 2011, she co-founded a nonprofit called Community Payee Partnership, which helps severely mentally ill people, people addicted to drugs and homeless people manage their disability benefits. In addition to running that organization, she works part time in the locked psych unit at St. Francis and represents the hospital in court when it’s seeking to conserve severely mentally ill people.

Rodriguez and I talked about her work and why she thinks Wiener’s legislation would make a difference. Answers have been edited for length and clarity. To hear the whole conversation, listen to the San Francisco City Insider podcast at sfchronicle.com/insider.

Rachel Rodriguez (l to r), director and co-founder Community Payee Partnership, talks with client Lawrence Rosenberg as he picks up a check at a Community Payee Partnership office on Thursday, March 7, 2019 in San Francisco, Calif.

Photo: Lea Suzuki / The Chronicle

Q: Of the people who are in conservatorship court, what kinds of behavior would get them there in the first place?

A: It’s a danger to self, so a suicide attempt, or a danger to others, so they might have been physically assaultive or made threats, but most often it’s grave disability.

Most often it’s the person who, due to their severe psychiatric condition, which is often related to schizophrenia, substance use and or bipolar disorder, it’s resulted in them being unable to meet their own basic needs for food, clothing and shelter.

We had a patient very recently who we picked up from a bus stop across from our hospital who had been covered in urine and feces, and unable to make any kind of plan for how to care for himself, and has chronic schizophrenia. This is somebody we can’t just leave on the streets — they have to be brought in and given care.

Q: Can you talk about some memorable patients?

A: Last summer, I had this guy who’s 35 and he came in, brought in by police. He’d been abusing methamphetamines quite heavily. He was underweight, malnourished, he was uncomfortable to look at. He had scabs on his face. His hair was in terrible condition.

He had a deformity in his hand which made it impossible for him to use it effectively. He’d been hit by a car while running into traffic in a meth-induced psychosis. He was disinterested in care and didn’t seek medical attention. Now he’s permanently left with this disability as a result.

He had dozens of hospitalizations, jail time, crisis visits and 15 years of homelessness. After keeping him for 14 days, he just wanted to go back on the streets. We let him go. Our hands are tied.

Alan Gordon meets with Rodriguez, director and co-founder of the nonprofit Community Payee Partnership, which helps clients manage disability benefits.

Photo: Lea Suzuki / The Chronicle

Q: You support Scott Wiener’s legislation, SB1045, to expand conservatorship. Can you talk about what it would do?

A: We currently have laws to treat people on conservatorship, which I would call more long-term intensive care, if they have a serious mental illness or alcoholism. We do not have laws right now that would allow us to do so when somebody has been using other drugs, and we see the methamphetamine crisis we have on our streets today. These are the people who are falling through the cracks. If we pass SB1045, we would have the opportunity to sew up this safety net. We can’t treat people any longer in a way that discards folks for using drugs.

Q: If you could wave a magic wand and fix the mental health system in San Francisco, California and the country, what would you do?

A: We could use 100 more beds immediately in this city, and then we’d be able to stabilize people more fully before they’re forced to go back out on the streets.

Q: What is something you would teach everyday San Franciscans about the mentally ill or severely drug-addicted people we see on the sidewalks?

A: These folks you see on the street acting out — who are scary, who are scaring themselves, who are very terrified and traumatized — they can get well. We see the change on the psych unit. We see that after a couple weeks — sometimes, of care, of them having a safe place, medication, a treatment team behind them, one-to-one meetings, groups, food, clothing and shelter — we’re seeing they improve and are back to the personalities their family and friends know they have.

Heather Knight is a columnist working out of City Hall and covering everything from politics to homelessness to family flight and the quirks of living in one of the most fascinating cities in the world. She believes in holding politicians accountable for their decisions or, often, lack thereof – and telling the stories of real people and their struggles.